Palmar Fasciectomy

Expert Hand Surgeons in Orange County, CA

A Palmar Fasciectomy is a surgical procedure used to divide or remove the thickened tissue in the palm of your hand or fingers with the goal of treating Dupuytren’s disease. Your hand surgeon at Newport Orthopedic Institute will discuss treatment options with you to determine if this is the right treatment for your condition.

What Is Dupuytren’s Contracture?

Dupuytren’s disease is a hand deformity that develops over years. This condition causes the fibrous layer of connective tissue that lies just underneath the skin in your palm and fingers, called the fascia, to thicken and tighten. The affected finger(s) will be pulled in towards your palm flexed or curled up, making it more challenging to use the hands for certain fine motor skills, like holding a pencil and putting your hands in your pocket. If the disease progresses slowly, causing no pain and has little impact on your ability to use your hands to perform daily tasks, you may not need treatment. However, this condition tends to progress over time and may require one of these two Dupuytren’s procedures.

What Is Palmar Fasciectomy?

A palmar fasciectomy, or Dupuytren’s fasciectomy, is typically an outpatient procedure performed under general or regional anesthetic. A board-certified orthopedic hand surgeon will make an incision in your hand and will remove all or part of the thin sheet of connective tissue in the hand (the palmar fascia) beneath the palm-side of the hands. The surgeon removes the diseased tissue through several types of incisions and separates it from nearby tendons, nerves, and digitals arteries. This will allow the fingers to move more naturally. The operation may be partial or total fasciectomy, depending on how much abnormal tissue is removed in the affected hand. The procedure is done by making an incision to expose the palmar fascia and then once the diseased tissue that causes the fingers to flex is removed, your doctor will wrap the treated hand with gauze. Sometimes, more than one finger needs treatment, but usually, this procedure is done on an outpatient basis so you can go home the same day as the surgery.

There are four types of fasciectomy procedures depending on the severity of the case, they include:

1. Enzymatic Fasciectomy (Xiaflex): This nonsurgical but still procedure-based approach uses a chemical enzyme (collagenase – Xiaflex) to dissolve a portion of the diseased palmar fascia (cord) that is causing a finger contracture. It is a two day approach where day one, the cord is injected. The subsequent day, the hand is numbed and the finger is pulled straight in order to rupture the cord and leading to a straighter finger. The benefits of this nonsurgical approach are that it requires less rehabilitation. Recurrence rate is on average 3-5 years. However, not everyone is a good candidate for this procedure.
2. Segmental Fasciectomy: A Short segment of the cord is removed through one or more small incisions along the joint creases. The benefit of this approach is that it is less surgery overall and easier rehabilitation process. Recurrence rates are around 3 years.
3. Regional or Subtotal Fasciectomy: Nearly all of the diseased fascia is removed along the affected fingers. This involves excising only the fascia that is diseased or affected. In the palm, this includes the pretendinous cords and part of the natatory ligaments. In the finger, the diseased fascia is called spiral and retrovascular cords. The goal of this procedure is to remove as much damaged tissue as safely as possible to prolong the time for regrowth and possible reoccurrence. Recurrence rate is on average 7-10 years.
4. Dermofasciectomy: This more aggressive approach is usually reserved for possible recurrent Dupuytrens disease or a more significant, initial involvement. This procedure involves not only excising the diseased palmar fascia, but also excising some of the overlying skin. This approach often necessitates skin grafting from a donor site.

A palmar fasciectomy is used to treat more severe cases of Dupuytren’s Contracture. It is more effective than a needle fasciotomy (or needle aponeurectomy) in the long term, and that is why the hand surgeons at Newport Orthopedic Institute no longer offer that procedure. A fasciectomy is considered to be an invasive surgery and can take weeks to months of hand therapy to heal. Hand therapy will usually be required and prescribed by your orthopedic hand surgeon. The purpose of hand therapy is to help you with exercises and movements that will restore function and movement of your fingers and hands.

Schedule a consultation with a Newport Orthopedic Institute orthopedic hand surgeon for palmar fasciectomy in Orange County by calling (949) 722-7038.